Acute Hospital Wards Research Articles

The canary in the coal mine: Continence care for people with dementia in acute hospital wards as a crisis of dehumanization.

Continence is a key moment of care that can tell us about the wider care of people living with dementia within acute hospital wards. The spotlight is currently on the quality of hospital care of older people across the UK, yet concerns persist about their poor treatment, neglect, abuse, and discrimination within this setting. Thus, within hospitals, the care of people living with dementia is both a welfare issue and a human rights issue. The challenge of continence care for people living with dementia can be seen as the ‘canary in the coal mine’ for the unravelling of dignity within the acute setting. This paper draws on an ethnographic study within five hospitals in England and Wales, selected to represent a range of hospital types, geographies and socio‐economic catchments. Observational fieldwork was carried out over 154 days in acute hospitals known to admit large numbers of people living with dementia. This paper starts to fill the gap between theory and data by providing an in‐depth ethnographic analysis examining the ways in which treatment as a person is negotiated, achieved or threatened. We examine how the twin assaults on agency of a diagnosis of dementia and of incontinence threaten personhood. The acute threats to this patient group may then act to magnify perils to treatment as a person. Our findings suggest that personal dignity and the social construction of moral personhood are both threatened and maintained in such a setting. We show how empirical ethnographic data can lend weight to, and add detail to, theoretical accounts of moral personhood and dignity.

A comparison of hospital and community stay in patients who underwent compulsory admission before and after the 2007 Amendment to the Mental Health Act in Taiwan

ObjectiveThe main purpose of this study was to assess the empirical findings of compulsory admission for psychiatric disorders before and after the 2007 amendment to the Mental Health Act in Taiwan. MethodsA matched case-control study design was applied. Participants were selected using the National Health Insurance Research Database (NHIRD) in Taiwan. The control and case data were collected in 2006 and 2011, and the number of compulsory admission cases was recorded with a case-control ratio of 1:4, along with information on age (±3 years) and gender. In 2006, the number of patients recruited was 9265, including 1853 compulsorily admitted patients and 7412 voluntarily admitted patients. In 2011, the number of patients recruited was 4505, including 901 compulsorily admitted patients and 3604 voluntarily admitted patients. ResultsThe data collected for the patients who underwent compulsory admission before and after the amended Mental Health Act included gender, diagnosis, Charlson Comorbidity Index Score (CCIS), length of stay in an acute hospital ward (days), hospital accreditation level, ownership, teaching hospital status, psychiatrist gender and age, and hospital location. Although the number of compulsory admission cases (1853 vs. 901) markedly decreased and the length of stay in an acute hospital ward (30.7 ± 25.0 days vs. 39.0 ± 22.6 days) increased from 2006 to 2011, the readmission rate was reduced from 52.6% in 2006 to 42.5% in 2011. ConclusionsThe average lengths of hospital stay and community survival time were greater for compulsorily admitted patients than those for voluntarily admitted patients. This result might be attributed to a number of changes implemented since the 2007 amendment of the Mental Health Act, including a strict review process for compulsory admissions and a new discharge planning process, which require further research for approval.

Impact of a multiplex PCR point-of-care test for influenza A/B and respiratory syncytial virus on an acute pediatric hospital ward

Patients with respiratory infections are often managed presumptively until confirmation of infection status. We assessed the impact of introducing the Enigma® MiniLab™ FluAB-RSV point-of-care test (POCT) on patients admitted with a suspected respiratory virus driven illness in an acute pediatric ward. This utilized a before and after design (respiratory viral seasons 2013/14 versus 2014/15). Following POCT implementation, oseltamivir prescribing increased in patients with influenza (OR = 12.7, P = 0.05, 95% CI [1.0, 153.8]). A reduction in the average reimbursement charges without a change in the length of stay was observed. Modeling suggested that laboratory test cost savings could be achieved if the POCT cost £30 and was used for screening, followed by the respiratory viral panel for RSV and influenza negative patients. A rapid POCT for influenza A/B and RSV infections in pediatric inpatients may improve oseltamivir prescribing, strengthen antimicrobial stewardship, reduce reimbursement charges and decrease laboratory costs.

Resuscitation decisions at the end of life: medical views and the juridification of practice

BackgroundConcerns about decision making related to resuscitation have led to two important challenges in the courts resulting in new legal precedents for decision-making practice. Systematic research investigating the experiences of...

Risks and prevalence of pressure ulcers among patients in an acute hospital in Finland.

To quantify pressure ulcer (PU) prevalence and to describe and identify the PU risk factors in acute hospital wards. A descriptive quantitative study was performed in 13 wards in a central hospital in Finland. The study included PU risk evaluation using the Braden risk assessment method, and full skin and medical assessment of consenting adult patients. Patients in paediatric, maternity and psychiatric wards, and in the intensive care unit were excluded. Patient's PUs were examined on the ward, and evaluated and classified using the international European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel (EPUAP/NPUAP) Pressure Ulcer Classification System. Demographic data, the Braden risk assessment scale, skin assessment, and the location and severity of PUs were also recorded. A sample of 229 inpatients was examined for signs of PUs on one day in 2013. The overall PU prevalence was 8.7% (20 patients). Of those assessed as 'at risk of developing PUs', four patients (1.7%) were considered at 'very high risk', 39 patients (17.0%) at 'high risk', and 60 patients (26.2%) with a 'moderate risk'. The patient's age and length of treatment period were associated with PU risk, while only length of treatment period was associated with PU prevalence. Older patients had a higher risk of PUs than younger ones. The longer the hospital stay, the higher the PU risk was. In addition, patients with a long hospital stay more often had a PU. According to the study, PUs occur with significant frequency in acute hospital wards. It is important to carry out PU prevention actions among all patient groups, but risk increases among older patients and those who, for any reason, stay in hospital for a longer period of time.

Short National Early Warning Score — Developing a Modified Early Warning Score

IntroductionEarly Warning Score (EWS) systems have been developed for detecting hospital patients clinical deterioration. Many studies show that a National Early Warning Score (NEWS) performs well in discriminating survival from death in acute medical and surgical hospital wards. NEWS is validated for Portugal and is available for use. A simpler EWS system may help to reduce the risk of error, as well as increase clinician compliance with the tool. ObjectivesThe aim of the study was to evaluate whether a simplified NEWS model will improve use and data collection. MethodsWe evaluated the ability of single and aggregated parameters from the NEWS model to detect patients’ clinical deterioration in the 24h prior to an outcome. There were 2 possible outcomes: Survival vs Unanticipated intensive care unit admission or death. We used binary logistic regression models and Receiver Operating Characteristic Curves (ROC) to evaluate the parameters’ performance in discriminating among the outcomes for a sample of patients from 6 Portuguese hospital wards. ResultsNEWS presented an excellent discriminating capability (Area under the Curve of ROC (AUCROC)=0.944). Temperature and systolic blood pressure (SBP) parameters did not contribute significantly to the model. We developed two different models, one without temperature, and the other by removing temperature and SBP (M2). Both models had an excellent discriminating capability (AUCROC: 0.965; 0.903, respectively) and a good predictive power in the optimum threshold of the ROC curve. ConclusionsThe 3 models revealed similar discriminant capabilities. Although the use of SBP is not clearly evident in the identification of clinical deterioration, it is recognized as an important vital sign. We recommend the use of the first new model, as its simplicity may help to improve adherence and use by health care workers.

Impact of disinvestment from weekend allied health services across acute medical and surgical wards: 2 stepped-wedge cluster randomised controlled trials

Impact of disinvestment from weekend allied health services across acute medical and surgical wards: 2 stepped-wedge cluster randomised controlled trials

Evaluating the impact of an Acute Care at Home service on acute hospital admissions

Introduction: Transforming Your Care (1) provided the blueprint for the future of Healthcare in Northern Ireland. It recognised some of the real challenges faced by Health Trusts and outlined the key areas for modernisation to enable services to meet the increasing demands from a growing and ageing population. Practice Change Implemented: In September 2014, the Southern Trust developed a consultant-led multidisciplinary team to deliver acute care to older people in their own home or in Nursing and Residential Homes. The service aimed to reduce pressure on emergency departments and acute hospital beds by preventing patients with non-critical care needs being admitted to hospital. Aim and Theory of Change: This study assessed the impact of access to a consultant led Acute Care At Home (ACAH) on unscheduled admissions to hospital. Timeline: Service evaluation took place from 1st September 2014 to 31st August 2015. Population of Focus: Over 75 year olds, Referred from 17 GP practices (100,000 population, 4,500 over 75 year olds). Innovations: Each patient received a comprehensive assessment by the ACAH team within 2 hours of being referred by their GP and had the same access to laboratory and diagnostic investigations as patients in an acute hospital ward. The service offers IV antibiotics, IV Diuretics, subcutaneous fluids and mobile ECG monitors, bladder scanners and blood testing in the patient’s own home. Impact and Outcomes: The service received a total of 358 referrals from GPs in the period from 1st September 2014 to 31st August 2015, 301 of these referrals were accepted onto the scheme. The GP practices which had access to the ACAH service had an increase in admissions for over 75 year olds from 186 to 197 per month (6% increase), compared to an increase of 525 to 609 per month (16% increase) from the GP practices which did not have access to the service. This reduction in admissions provided a saving in acute services of approximately £570,000. Service user feedback has been universally positive with one patient’s daughter writing, “The respect and courtesy given to my elderly mother by the team during this difficult time was nothing less than outstanding. This is an exceptional service and all those involved in the team should be extremely proud of it.” Comments on sustainability: The model has been demonstrated to be a cost effective alternative to acute hospital based cared and has other long terms effects in terms of requirements for ongoing care Comments on Transferability: The Southern Trust has extended the service to over 240,000 patients. Other Trusts in Northern Ireland have used the model as a blueprint for developing their ACAH service. Conclusion: The introduction of an ACAH service has reduced unscheduled care admissions for over 75 year olds. Lessons Learned: GPs are a key stakeholder in this service. A daily Multidisciplinary Team (MDT) meeting is essential to ensure this group of acutely unwell patients are cared for in a safe and effective manner with changes to treatment plans requiring consensus from the MDT and patient. Given the complexity and acuity of patients consultant oversight is important.

Introducing a discharge planning and resource folder on acute hospital wards: A simple intervention to improve communication and quality of care at discharge

Introduction: Hospital discharge especially for those patients with complex needs requires good coordination between hospital and community services. Communication with patients, families and community healthcare teams is vital on discharge. Failure to enlist appropriate community services on discharge home may leave patients vulnerable to adverse outcomes and readmission. Our hospital actively manages discharge procedures through our hospital planning committee. A survey of nurses in our hospital on discharge processes identified a lack of knowledge of relevant community services and also time wasted searching for contact details and other discharge information. A hospital project on readmissions highlighted inadequate discharge communication as an area for improvement. Practice change: “Discharge Planning & Resource” folders were introduced to all wards. Existing hospital discharge procedures, referrals forms for community services and patient information leaflets were reviewed, updated and collated. The contact details of local health-centres, public health nurses and nursing homes were gathered. An electoral listing of streets in our catchment area matched to their community health-centre was assembled. All this information was arranged in standardised folders. The roll-out of the folders was accompanied by ward based education on the discharge process. Aim: Achieving a safe, timely and person-centred discharge from hospital to home is our ultimate goal. The aim of this project was to introduce a standardised “go-to” discharge planning resource on each ward. The objective was to aid effective communication and onward referrals to relevant community services at discharge. Targeted population: This project focused on the medical and surgical wards in the hospital. Nurses were seen as key staff in terms of communication with community supports at the time of discharge. Discharge coordinators and ward nurses worked together identifying the essential information for discharge planning. The multidisciplinary discharge planning committee could to sustain and update the information folders. Highlights: A standardised “Discharge Planning & Resource” folder for the hospital was developed and successfully introduced to all wards. This folder is colour coded in a standardised fashion aiding staff moving between wards. The procedures for discharge to home, nursing home, hospice care or rehabilitation beds are available in one “go-to” resource. Information on arranging oxygen, looking after nephrostomy tubes and other patient information are available to staff in the one place. Criteria and referral forms for the different support services at discharge are now all available. There is a high level of staff satisfaction and increased knowledge about discharge processes. This simple initiative could easily be replicated elsewhere. Conclusions & Discussion: Communication is fundamental to successful and safe discharge. A single “go-to” resource for discharge planning information can aid staff in organising timely discharges and communicating with community services. Education, training and availability of adequate information are essential for improving discharge processes from hospital. Lessons learned: Simple low-cost strategies can have significant positive effects Hospital staff may not be aware of all community services Lack of communication can be due to lack of contact details rather than lack of desire Improving hospital discharge processes has potential to improve quality-of-lives for patients

An algorithm to be used nationally for delirium screening and treatment in acute hospital wards: lessons from the development process

Introduction: Delirium (acute confusion) affects 1 in 8 acute hospital inpatients and is highly distressing for patients and families. It is associated with increased length of hospital stay, risk of falls, mortality and institutionalisation. Early detection improves outcome, whereas established delirium (present for a few days) is difficult to treat. Thus screening for delirium in at-risk patients is key to early detection and treatment to improve outcomes. Description of policy context and objective: NICE guidelines recommend daily delirium screening for high risk patient groups. However, delirium screening and assessment is poorly performed in Irish hospitals (Irish National Audit of Dementia, 2014). We aimed to develop a simple algorithm for delirium screening on hospital wards, helping staff to identify those patients requiring daily delirium screening and outlining the action to be taken when a patient screened positive for delirium. Targeted population: Hospital in-patients on any general medical or surgical ward (i.e. excluding Intensive Care Unit or orthopaedic/neurosurgery wards), with ward nurses performing the daily delirium screening and hospital doctors acting on the abnormal result. Highlights: (innovation, Impact and outcomes) The interdisciplinary national algorithm development team firstly developed an evidence-based algorithm. Two versions were developed- one using the 4AT test (a well-recognised short delirium screening test) and the other using a quicker, deconstructed form. Both versions were piloted in three hospital sites, in a single ward at each site, with extensive user evaluation of the algorithm. Further modification was performed, followed by a second pilot in a single hospital on four wards. The version using the regular 4AT was preferred by users. Staff required pre-use training particularly on how to score patient refusals and using the tool in a patient with severe dementia. A Frequently Asked Questions guide, and an online training tool were developed, to support staff use of the algorithm, based on the pilot studies. This algorithm is being rolled out nationally in 2017 so impact and outcomes can’t be assessed as yet. Comments on transferability: The delirium algorithm was developed for use in all acute hospitals in Ireland. It is highly transferrable to other countries. Conclusions: Any new policy or guideline requires extensive user engagement at all stages of development. Different hospitals have different resources and training needs. Extensive piloting of our proposed algorithm identified areas that required targeted training. This allowed resources to be developed to facilitate adoption of the national policy, targeted to specific end-users needs.

What impact does nursing care left undone have on patient outcomes? Review of the literature.

Aims and objectivesSystematic review of the impact of missed nursing care on outcomes in adults, on acute hospital wards and in nursing homes.BackgroundA considerable body of evidence supports the hypothesis that lower levels of registered nurses on duty increase the likelihood of patients dying on hospital wards, and the risk of many aspects of care being either delayed or left undone (missed). However, the direct consequence of missed care remains unclear.DesignSystematic review.MethodsWe searched Medline (via Ovid), CINAHL (EBSCOhost) and Scopus for studies examining the association of missed nursing care and at least one patient outcome. Studies regarding registered nurses, healthcare assistants/support workers/nurses’ aides were retained. Only adult settings were included. Because of the nature of the review, qualitative studies, editorials, letters and commentaries were excluded. PRISMA guidelines were followed in reporting the review.ResultsFourteen studies reported associations between missed care and patient outcomes. Some studies were secondary analyses of a large parent study. Most of the studies used nurse or patient reports to capture outcomes, with some using administrative data. Four studies found significantly decreased patient satisfaction associated with missed care. Seven studies reported associations with one or more patient outcomes including medication errors, urinary tract infections, patient falls, pressure ulcers, critical incidents, quality of care and patient readmissions. Three studies investigated whether there was a link between missed care and mortality and from these results no clear associations emerged.ConclusionsThe review shows the modest evidence base of studies exploring missed care and patient outcomes generated mostly from nurse and patient self‐reported data. To support the assertion that nurse staffing levels and skill mix are associated with adverse outcomes as a result of missed care, more research that uses objective staffing and outcome measures is required.Relevance to clinical practiceAlthough nurses may exercise judgements in rationing care in the face of pressure, there are nonetheless adverse consequences for patients (ranging from poor experience of care to increased risk of infection, readmissions and complications due to critical incidents from undetected physiological deterioration). Hospitals should pay attention to nurses’ reports of missed care and consider routine monitoring as a quality and safety indicator.

Lack of meaningful activity on acute physical hospital wards: Older people’s experiences

Introduction Research suggests that older people on acute physical hospital wards are at increased risk of physical and mental health decline due to inactivity during their stay. Whilst studies have highlighted potential causes of such inactivity, there exists a paucity of occupational therapy research that explores engagement in meaningful occupation from patients’ perspectives in hospital settings. Method Interpretative phenomenological analysis was used to gain a deeper understanding of how 18 older people spent their time on hospital wards and the impact this had on their feelings of wellbeing. Interviews were carried out and analysed using interpretive phenomenological analysis guidelines. Findings Patients experienced a lack of meaningful activity on the wards which resulted in feelings of passivity, boredom and a sense of alienation from their normal roles, routines and sense of self. Despite a willingness to engage in activity, barriers were suggested as limited resources, hospital routines and personal limitations. Suggestions of potential meaningful activities were made. Conclusion Occupational therapy services need to review service provision and provide an occupation-focused service, ensuring that patients’ engagement in meaningful activities is seen as an integral part of their role in order to maintain patients’ mental and physical wellbeing. Recommendations for further research are highlighted.

Exploring how ward staff engage with the implementation of a patient safety intervention: a UK-based qualitative process evaluation

ObjectivesA patient safety intervention was tested in a 33-ward randomised controlled trial. No statistically significant difference between intervention and control wards was found. We conducted a process evaluation of the...

Nursing work and sensory experiences of hospital design: A before and after qualitative study following a move to all-single room inpatient accommodation

The embodied experience of nursing practice is rarely studied. Drawing on data from an internationally relevant larger study conducted in 2013–14, here we explore the sensory dimension of the embodied experiences of nursing staff working on two acute NHS hospital wards before and after a move to all-single room inpatient accommodation. We undertook a secondary analysis of 25 interviews with nursing staff (12 before and 13 after the move with half [13/25] using photographs taken by participants) from a mixed-method before-and-after study. This analysis focused on the sensory dimensions of nursing staff's experiences of their working practices and the effect of the built environment upon these. Drawing on Pallasmaa's theoretocal insights, we report how the all-single room ward design prioritises ‘focused vision’ and hinders peripheral perception, whilst the open ward environment is rich in contextual and preconscious information. We suggest all-single room accommodation may offer staff an impoverished experience of caring for patients and of working with each other.

Improving comfort around dying in elderly people: a cluster randomised controlled trial

Over 50% of elderly people die in acute hospital settings, where the quality of end-of-life care is often suboptimum. We aimed to assess the effectiveness of the Care Programme for the Last Days of Life (CAREFuL) at improving comfort and quality of care in the dying phase in elderly people. We did a cluster randomised controlled trial in acute geriatric wards in ten hospitals in Flemish Region, Belgium, between Oct 1, 2012, and March 31, 2015. Hospitals were randomly assigned to implementation of CAREFuL (CAREFuL group) or to standard care (control group) using a random number generator. Patients and families were masked to interventaion allocation; hospital staff were unmasked. CAREFuL comprised a care guide for the last days of life, training, supportive documentation, and an implementation guide. Primary outcomes were comfort around dying, measured with the End-of-Life in Dementia-Comfort Assessment in Dying (CAD-EOLD), and symptom management, measured with the End-of-Life in Dementia-Symptom Management (SM-EOLD), by nurses and family carers. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01890239. 451 (11%) of 4241 beds in ten hospitals were included in the analyses. Five hospitals were randomly assigned to standard health care practice and five to the CAREFuL programme; 118 patients in the control group and 164 in the CAREFuL group were eligible for assessment. Assessments were done for 132 (80%) of 164 patients in the CAREFuL group and 109 (92%) of 118 in the control group by nurses, and 48 (29%) in the CAREFuL group and 23 (19%) in the control group by family carers. Implementation of CAREFuL compared with control significantly improved nurse-assessed comfort (CAD-EOLD baseline-adjusted mean difference 4·30, 95% CI 2·07-6·53; p<0·0001). No significant differences were noted for the CAD-EOLD assessed by family carers (baseline-adjusted mean difference -0·62, 95% CI -6·07 to 4·82; p=0·82) or the SM-EOLD assessed by nurses (-0·41, -1·86 to 1·05; p=0·58) or by family carers (-0·59, -3·75 to 2·57; p=0·71). Although a continuous monitoring of the programme is warranted, these results suggest that implementation of CAREFuL might improve care during the last days of life for patients in acute geriatric hospital wards. The Flemish Government Agency for Innovation by Science and Technology and the Belgian Cancer Society "Kom Op Tegen Kanker".

Nurses' contributions to the resolution of ethical dilemmas in practice.

Complex and expensive treatment options have increased the frequency and emphasis of ethical decision-making in healthcare. In order to meet these challenges effectively, we need to identify how nurses contribute the resolution of these dilemmas. To identify the values, beliefs and contextual influences that inform decision-making. To identify the contribution made by nurses in achieving the resolution of ethical dilemmas in practice. An interpretive exploratory study was undertaken, 11 registered acute care nurses working in a district general hospital in England were interviewed, using semi-structured interviews. In-depth content analysis of the data was undertaken via NVivo coding and thematic identification. Participants and context: Participants were interviewed about their contribution to the resolution of ethical dilemmas within the context of working in an acute hospital ward. Participants were recruited from all settings working with patients of any age and any diagnosis. Ethical considerations: Ethical approval was obtained from the local National Research Ethics Committee. Four major themes emerged: 'best for the patient', 'accountability', 'collaboration and conflict' and 'concern for others'. Moral distress was also evident in the literature and findings, with moral dissonance recognised and articulated by more experienced nurses. The relatively small, single-site sample may not account for the effects of organisational culture on the results; the findings suggested that professional relationships were key to resolving ethical dilemmas. Nurses use their moral reasoning based on their beliefs and values when faced with ethical dilemmas. Subsequent actions are mediated though ethical decision-making frames of reference including deontology, consequentialism, the ethics of care and virtue ethics. Nurses use these in contributing to the resolution of these dilemmas. Nurses require the skills to develop and maintain professional relationships for addressing ethical dilemmas and to engage with political and organisational macro- and micro-decision-making. Nurses' professional relationships are central to nurses' contributions to the resolution of ethical dilemmas.

Prevalence of Risk Factors for the Refeeding Syndrome in Older Hospitalized Patients.

The incidence of refeeding syndrome (RFS) in older patients is not well-known. The aim of the study was to determine the prevalence of known risk factors for RFS in older individuals during hospitalization at geriatric hospital departments. 342 consecutive older participants (222 females) who admitted at acute geriatric hospital wards were included in a cross-sectional study. We applied the National Institute for Health and Clinical Excellence (NICE) criteria for determining patients at risk of RFS. In addition, Mini Nutritional Assessment Short Form (MNA®-SF) was used to identify patients at risk of malnutrition. Weight and height were assessed. The degree of weight loss was obtained by interview. Serum phosphate, magnesium, potassium, sodium, calcium, creatinine and urea were analyzed according to standard procedures. Of 342 older participants included in the study (mean age 83.1 ± 6.8, BMI range of 14.7-43.6 kg/m2), 239 (69.9%) were considered to be at risk of RFS, in which 43.5% and 11.7% were at risk of malnutrition and malnourished, respectively, according to MNA-SF. Patients in the risk group had significantly higher weight loss, lower phosphate and magnesium levels. In a multivariate logistic regression analysis, low levels of phosphate and magnesium followed by weight loss were the major risk factors for fulfilling the NICE criteria. The incidence of risk factors for RFS was relatively high in older individuals acutely admitted in geriatric hospital units, suggesting that, RFS maybe more frequent among older persons than we are aware of. Patients with low serum levels of phosphate and magnesium and higher weight loss are at increased risk of RFS. The clinical characteristics of the older participants at risk of RFS indicate that these patients had a relatively poor nutritional status which can help us better understand the potential scale of RFS on admission or during the hospital stay.

Clinical establishments.

Safe, Sustainable and Productive Staffing: An Improvement Resource for Adult Inpatient Wards in Acute Hospitals is based on the National Quality Board's expectations of safe, effective and well led care, and builds on the National Institute for Health and Care Excellence guidelines on safe staffing for nursing in adult wards.

Abstract WMP118: In Safe Hands: Implementation on the Stroke Unit. Does it Improve Patient Care and Ward Efficiency?

The ‘In Safe Hands” (ISH) is a structured interdisciplinary bedside round developed to increase patients participation in their care in acute hospital wards. This has shown to improve quality of care by reducing communication errors and complications, enhancing a culture of safety in an acute hospital. The purpose of this study was to assess the effect of ISH on length of stay (LOS), in-hospital complications and assess whether the ISH enhances patient and staff satisfaction in a stroke unit of a tertiary hospital in Sydney, Australia. This was a longitudinal study pre and post implementation. A total of 200 patients participated in the study. Data on the length of stay, incidence rate relating to patient safety and patient and staff satisfaction surveys using Patient Experience Tracker (PET) devices were collected pre and post implementation. ISH increased the number of patients with at least 72hours in stroke unit care by 80 percent (P &lt; 0.001). Fever and hyperglycaemia were treated in all patients following ISH implementation vs only 50% and 64% respectively of patients pre ISH implementation. Swallow screen was completed in all patients prior oral intake compared to 92% of patients of the pre ISH group (P = 0.03). There was no significant difference in the LOS and complications. All stroke patients received stroke education and there were no readmissions post implementation. There was no significant difference in the patient and staff satisfaction. In conclusion, although ISH did not improve the primary endpoints of LOS, complications and satisfaction it did improve protocol adherence.

Prevalence and Clinical Correlates of Sarcopenia, Identified According to the EWGSOP Definition and Diagnostic Algorithm, in Hospitalized Older People: The GLISTEN Study.

Prevalence of sarcopenia is substantial in most geriatrics settings, but estimates vary greatly across studies because of difference in population characteristics, diagnostic criteria, and methods used to assess muscle mass, muscle strength, and physical performance. We investigated the feasibility of the European Working Group on Sarcopenia in Older People (EWGSOP) algorithm assessment in hospitalized older adults and analyzed prevalence and clinical correlates of sarcopenia. Cross-sectional analysis of 655 participants enrolled in a multicenter observational study of older adults admitted to 12 acute hospital wards in Italy. Sarcopenia was assessed as low skeletal mass index (kg/m2) plus either low handgrip strength or low walking speed (EWGSOP criteria). Skeletal muscle mass was estimated using bioimpedance analysis. Of the 655 patients (age 81.0 ± 6.8 years; women 51.9%) enrolled in the study, 275 (40.2%) were not able to perform the 4-m walking test because of medical problems. The overall prevalence of sarcopenia on hospital admission was 34.7% (95% confidence interval 28-37) and it steeply increased with aging (p < .001). In multivariable analysis, patients with sarcopenia on hospital admission were older and were more likely to be male and to have congestive heart failure, cerebrovascular disease, and severe basic activities of daily living disability. The prevalence of sarcopenia was inversely correlated with body mass index. Based on EWGSOP criteria, prevalence of sarcopenia is extremely high among older adults on admission to acute hospital wards. Older age, male gender, congestive heart failure, cerebrovascular disease, severe activities of daily living disability, and body mass index were the clinical variables significantly associated with the presence of sarcopenia.